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Athetosis

  • not a disorder or disease

  • athetosis means without fixed position

  • can be seen as a symptom in cerebral palsy and Huntington's disease

Ataxia as a disorder

Hoare, B., Wallen, M., Imms, C., Villanueva, E., Rawicki, H., &

Carey, L. (2010, January 10). Botulinum toxin A as an adjunct to treatment in the management of the upper limb in children with spastic cerebral palsy. Cochrane Database of Systematic Review. Retrieved from http://onlinelibrary.wiley.com.ezproxy.emich.edu/enhanced/doi/10.1002/14651858.CD003469.pub4

Novak, I., McIntyre, S., Morgan, C., Campbell, L., Dark, L.,

Morton, N., & Stumbles, E. (2013, August 21). A systematic review of interventions for children with cerebral palsy: State of the evidence. Developmental Medicine and Child Neurology, 55(10), 885-910. Retrieved from http://ry7wh7fe2u.search.serialssolutions.com.ezproxy.emich.edu/?genre=article&issn=00121622&title=Developmental%20Medicine%20&%20Child%20Neurology&volume=55&issue=10&date=20131001&atitle=A%20systemat

Famous people with Cerebral Palsy

RJ Mitte

References

  • Ataxia means without coordination

  • Individuals with ataxia have damage to the nervous system in areas that control muscle coordination

  • Ataxia can be used to describe a group of degenerative diseases but it is also used as a symptom of other conditions.

Abbey Curran

Bonner Paddock

Office of Communications and Public Liaison. (2014, November 13).

Cerebral Palsy Hope Through Research. In National Institute of Neurological Disorders and Stroke . Retrieved January 27, 2015, from http://www.ninds.nih.gov/disorders/cerebral_palsy/detail_cerebral_palsy.htm

Scholtes, V., Dallmeijer, A., Knol, D., Speth, L., Maathuis, C., Jongerius,

P., & Becher, J. (2006, December). The combined effect of lower-limb multilevel botulinum toxin type A and comprehensive rehabilitation on mobility in children with cerebral palsy: A randomized clinical trial. Archives of Physical Medicine and Rehabilitation, 18, 1551-1558. Retrieved from http://www.archives-pmr.org/article/S0003-9993(06)01325-6/pdf

Tieman, B., Palisano, R., Gracely, E., & Rosenbaum, P. (2004, May). Gross motor

capability and performance of mobility in children with cerebral palsy: A comparison across home, school, and outdoors/community settings. Journal of the American Physical Therapy Association, 84(5), 419-429. Retrieved from http://ptjournal.apta.org/content/84/5/419.full

The Ultimate Resource for Everything Cerebral Palsy. (2015). In My Child at

Cerebral Palsy.org. Retrieved January 30, 2015, from http://cerebralpalsy.org/about-cerebral-palsy/cause/when/

Symptoms

  • difficulty with balance and coordination
  • slurring of speech
  • fine motor impairment

Atchison, B., & Dirette, D. (2012). Conditions in Occupational

Therapy (4th ed., pp. 9-20). N.p.: Lippincott Williams and Wilkins.

Brandão, M., Gordon, A., & Mancini, M. (2012, December).

Functional impact of constraint therapy and bimanual training in children with cerebral palsy: A randomized controlled trial. Journal of Occupational Therapy, 66(6), 672-681. Retrieved from http://ry7wh7fe2u.search.serialssolutions.com.ezproxy.emich.edu/?genre=article&issn=02729490&title=American%20Journal%20of%20Occupational%20Therapy&volume=66&issue=6&date=20121101&atitle=Functional%20

Cerebral Palsy International Research Foundation. (n.d.). Facts about

Cerebral Palsy . In Global Research for Developmental Brain Disorders . Retrieved January 30, 2015, from http://cpirf.org/facts-about-cerebral-palsy/

Types

  • hereditary
  • sporadic
  • pure cerebellar
  • cerebellar plus

Other Interventions

Wallen, M., O’Flaherty, S., & Waugh, M. (2007, January). Functional

outcomes of intramuscular botulinum toxin type A and occupational therapy in the upper limbs of children with cerebral palsy: A randomized controlled trial. Archives of Physical Medicine and Rehabilitation, 88, 1-10. Retrieved January 30, 2015, from http://www.archives-pmr.org/article/S0003-9993(06)01425-0/pdf

(n.d.). In National Ataxia Foundation. Retrieved February 4, 2015, from

http://www.ataxia.org/learn/ataxia-diagnosis.aspx

HABIT

  • seating and positioning aids
  • orthotics
  • specialized tools
  • communication aids

(Hand arm bimanual intensive training)

Botulinum toxin A

"highly structured technique that provides

intensive training with graded functional activities tailored to the child's specific impairments and interests" (Brandao et. al, 2012).

  • focuses specifically on bimanual hand use.
  • works well with children

In another review by Hoare et al., it was found that

using BtA in conjunction with OT improved occcupational performance, goal attainment, and wrist flexor spasticity compared to those whose received no treatment.

Both literature reviews suggested that BtA should not be administered as the only treatment but used in adjunct with occupational therapy to improve movement and function (Hoare et al., 2010).

Occupational Therapy Interventions

Botulinum toxin A

(BtA)

  • CIMT
  • HABIT- hand arm bimanual intensive training

A study on these interventions revealed that these interventions had positive effects on independence and functional skills for self care in individuals with hemiplegic CP.

In an review of interventions for children

with cerebral palsy it was found that BtA

had strong quality of evidence for:

-reducing spasticity of the lower limbs and improved hand function performance and function when used in adjunct with OT.

The review also recorded that evidence quality for BtA in reducing pain and reducing hypotonia of the neck was very low (Novak et al., 2013).

Occupational Performance Issues

  • depends on severity of CP
  • limitations in range of motion and endurance
  • difficulties with gross motor movements, vision, and mobility
  • ADL's are affected:
  • difficulties with eating, speech, writing, and walking
  • environmental factors influence performance of individuals

Athetosis

  • Distinguished by slow writhing movements, fluctuation in muscle tone and excessive moving

  • Is a type of dyskinesia

  • When the person is agitated or upset the movements increase

  • Drooling, dysarthria, and difficulties with eating occur due to poor head and trunk control

Ataxia

  • Distinguished by staggering, unbalanced ambulation

  • Clumsiness when performing voluntary movement

  • Hypotonicity

  • Balance and depth perception are affected

Medical Management

Types of Cerebral palsy

Interventions for cerebral palsy include:

  • Adaptive and assistive equipment
  • Working with a multitude of professionals:
  • occupational therapists, physical therapists, speech pathologists, educational psychologists and social workers.
  • Botox injections
  • Medications to reduce spasticity
  • Splinting

Signs in infants over 6 months

Spastic hemiplegia/hemiparesis

Spastic diplegia/diparesis

Spastic quadriplegia/quadriparesis

Mixed

  • The baby still exhibits the asymmetrical tonic neck reflex
  • The baby reaches out with only one of their hands and keeps the other hand in a fist

Symptoms that do not fit into a certain category of CP

Signs in infants under 6 months

Spastic hemiplegia/hemiparesis

Spastic

Spastic quadriplegia/quadriparesis

  • The baby’s head lags when you pick them up from a supine position
  • The baby feels stiff or floppy
  • When the baby is picked up his or her legs make a scissor motion or become stiff
  • When the baby is cradled his or her back and neck seem to be overextended

  • Usually involves the arm and hand of one side of the body, sometimes the leg is involved
  • The arm and leg involved usually are shorter and thinner
  • The person may walk with on their tip toes
  • Speech is delayed but usually intelligence is usually normal

  • Most severe form of CP
  • Entire body is involved
  • Moderate to severe intellectual disability
  • Severe stiffness in legs but floppy neck
  • Seizures

More symptoms

Spastic diplegia/diparesis

Tone abnormalities including:

  • hypertonicity, hypotonicity, and fluctuating tone

Reflex abnormalities including:

  • Hyperreflexia, clonus, overflow, enhanced stretch reflex, lack of primitive reflexes, retaining primitive reflexes after normal duration

Postural abnormalities

  • Caused by abnormal reflexes and tone

Motor development delays

  • Unable to sit independently, failure to achieve motor milestones

Motor performance delays

  • Unusual crawling or walking methods, uncoordinated movements, difficulty with chewing or swallowing

  • Affects more of the lower limbs and the tendons in the legs are hyperactive
  • Scissor gait
  • Intelligence is usually normal

In babies over 10 months

Diagnosis of CP

Types of Cerebral Palsy

  • The baby crawls in a lopsided manner, one side of the body drags while the other pushes
  • The baby does not crawl on all fours but instead scoots around on his or her bottom
  • While it is often difficult to diagnose infants at age 1-2, parents should still seek pediatricians help if they have concerns. The pediatrician will refer them to an early intervention program if necessary

Athetoid (dyskinetic)

Ataxia

Mixed

  • No definitive test to diagnose
  • MRI, CT, cranial ultrasound, EEG
  • Evaluate motor skills

What are symptoms of Cerebral Palsy?

Risk factors

Intrapartum

The symptoms that can be seen in all variations of CP are:

Preconception

  • Premature placental separation
  • Uterine rupture
  • Acute maternal hypotension
  • Prolapsed umbilical cord
  • Tightened true knot of umbilical cord

  • Parents older than 35 years old
  • Parents who are very young
  • Environmental toxins
  • Genetic disorders
  • Malnutrition
  • Metabolic disorders
  • Radiation damage

Perinatal period and infancy

  • Endocrine
  • Hypoxia
  • Infection
  • Multiple births
  • Stroke
  • Trauma
  • Motor development and performance

  • Muscle tone

  • Reflexes

  • Postural abnormalities

1st trimester

3rd trimester

  • Endocrine function
  • Nutrition
  • Toxins
  • Maternal disease

  • Prematurity
  • Blood factors
  • Cytokines
  • Inflammation
  • Hypoxia
  • Infection

2nd trimester

  • Infection
  • Placental pathology

Etiology

  • The majority of cases of CP are known, some are still unknown.
  • Known causes:
  • Brain injury occurring prenatally ~ 70-80% of children with CP
  • Birth complications related to hypoxemia ~ 5-10%
  • Brain injury acquired after birth from stroke, infections, poisoning, trauma ~ 10%
  • Unknown causes:
  • 20-30% cases with early onset symptoms postnatally

Characteristics

  • CP is caused by brain injury or malformation during brain development.

  • Non-progressive

  • Always involves a sensorimotor disorder. This can be abnormally increased muscle tone (hypertonicity) or athetosis (writhing movements of limbs)

  • Sensorimotor disorder occurs in the brain not the spinal cord.

  • Lifelong disability

  • Approximately 30-50% of people with CP will have an intellectual disability.

What is Cerebral Palsy ?

  • Neurological non-progressive condition that involves groups of clinical syndromes rather than one specific condition.
  • Individuals with CP have affected:
  • Muscle tone
  • Muscle coordination and function
  • Difficulty with reflexes
  • Difficulty with balance

-Monique Tournaud

Cerebral Palsy

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